Obligation to consult and inform for DNR orders.

Doctors are now legally obliged to consult with, and inform, patients if they want to place a Do Not Resuscitate (DNR) order on their medical notes following a landmark judgment.

The requirement follows a Court of Appeal ruling which found that doctors at Addenbrooke's Hospital, in Cambridge, had acted unlawfully in not consulting with a terminal lung cancer sufferer who died there three years ago.

The family of Janet Tracey, 63, of Ware, Herts, said that neither she, nor they, were consulted when a DNA notice was placed on her notes after she was admitted following a serious car accident.

Guidelines for doctors already recommend that patients and families are involved in DNR decisions but the Court of Appeal ruling, by the Master of the Rolls, Lord Dyson, now makes it a firm legal requirement.

In the judgement, Lord Dyson, said the hospital trust violated Mrs Tracey's right to respect for her private life under Article 8 of the European Convention of Human Rights.

He said: "As a Do Not Attempt Cardiac Pulmonary Resuscitation decision is one which will potentially deprive the patient of life-saving treatment, there should be a presumption in favour of patient involvement. There need to be convincing reasons not to involve the patient.

"Doctors should be wary of being too ready to exclude patients from the process on the grounds that their involvement is likely to distress them".

Mrs Tracey’s husband, David, and daughters, were distressed when a DNR notice was put on her hospital records.

It was cancelled after they complained although a second was later put in place after talks with the family two days before Mrs Tracey died.

Since her death, David Tracey, has fought for a full judicial review to seek clarity over DNR notices and consent.

Richard Wood of the CNCI team said "This is a significant ruling for a number of reasons. At a clinical level it reflects the fundamental need to involve patients and their families in key decisions about treatment. By seeking judicial review at a time of personal loss the Tracey family have helped to clarify and protect the rights of thousands of others".

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